Sutter Health Plus Changing PBM to CVS Caremark from Express Scripts

Effective January 1, 2022, Sutter Health Plus is changing its pharmacy benefit manager (PBM) to CVS Caremark® from Express Scripts®. CVS Caremark will manage the pharmacy benefits for its members, including retail, mail order and specialty prescription drugs; claims processing; and prior authorization requests for drugs.

Sutter Health Plus is an HMO health plan that gives people access to many of Northern California’s most respected healthcare providers, including many of Sutter Health’s affiliated hospitals, doctors and physician organizations. 

Sutter Health Plus serves approximately 100,000 members from the Northern California foothills and the State Capitol to Silicon Valley and Santa Cruz. Members enjoy convenient features through its integrated delivery system, such as access to virtual care, Sutter Walk-In Care, pharmacy home delivery, an online patient portal, and a single number to call for care and coverage needs.

CVS Caremark is collaborating with Sutter Health Plus to make sure members get the right prescription drugs at the right time. In early January 2022, members will be able to create an individual account on the CVS Caremark member portal for access to many tools to help them understand the formulary and cost share options, including:

• View order and drug history
• Order refills online
• Automatic refill reminders for all of prescriptions (retail, mail order, specialty)
• Set communication preferences, for example email or text
• Check order status and track shipments
• Delivery of drugs within the United States, Monday through Friday, at no additional charge with most supplies provided, e.g., needles and syringes
• Safety checks to help prevent interactions with other drugs and products
• Access to specialty-trained pharmacists and nurses 24 hours a day, 7 days a week
• View claims information

CVS Caremark is one of the largest PBMs in the United States and serves over 105 million members across all 50 states, Puerto Rico, and the Virgin Islands.

Takeaway: The pharmacy benefit market continues to grow increasingly consolidated with the top three companies (Optum, Express Scripts and CVS Caremark) strengthening their position as new PBM entrants find it a difficult market to succeed primarily due to the customers established relationships with the market leaders